A recent Lancet article (McClure & Gandhi, 2025) warns that dismantling the US Agency for International Development (USAID) and halting programs like the President’s Emergency Plan for AIDS Relief (PEPFAR) could unleash a surge in drug-resistant infections worldwide.
In early 2025, an executive order froze all new US foreign aid. Within days, USD 450 million in annual PEPFAR funding for Tanzania disappeared—cutting off free HIV treatment for nearly 1.2 million people. At Consolata Ikonda Hospital, the HIV clinic has provided more than 44,000 free consultations since 2021—services now at risk if medication supplies and program funding are not restored.
PEPFAR, launched in 2003, is credited with saving 26 million lives and ensuring that by 2023, 93% of people with HIV in low- and middle-income countries were receiving dolutegravir, a highly effective, once-daily antiretroviral with a high barrier to resistance.
Now, clinic closures and drug shortages are forcing patients to ration medication or turn to poor-quality alternatives—conditions that foster resistance, particularly in HIV and tuberculosis. A USAID memo warns TB cases in Tanzania could rise by up to 32% within a year. The Lancet cites modelling studies showing that even a 90-day funding pause could cause more than 100,000 additional HIV-related deaths globally.
If widespread resistance emerges, it could undermine all WHO-recommended HIV treatments and the only approved long-acting injectable regimen—threatening decades of progress, even if programs are later restored.
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